Not All Plaque is Created Equal

Plaque density may prove an important factor when calculating risk for heart disease, heart attack and stroke, according to a recent study.

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Generally speaking, the buildup of plaque inside the arteries is bad news for heart health. When plaque builds up, it can harden and reduce or even block normal blood flow. It can also rupture, and if it travels to the heart or brain, can cause a heart attack or stroke. But not all plaque is created equal when it comes to heart attack and stroke risk, according to a recent study published in the Journal of the American Medical Association.

Led by researchers at the University of California, this study provided an in-depth look into the relationship between coronary artery calcium and risk for heart disease, heart attack and stroke. Coronary artery calcium is a type of buildup on the walls of coronary arteries that can be an early sign of heart disease and increase risk for cardiac events. Consequently, tests used to measure calcium buildup are used to identify high-risk patients who may need more aggressive treatment to reduce their risk of heart disease and cardiac events.

Between 2000 and 2002, nearly 3,400 men and women enrolled in this study, all of whom were free of heart disease at the start of the study. After performing initial tests to measure plaque buildup, researchers followed subjects for about 7.5 years to see who developed heart disease or suffered heart attack or stroke. By the study’s end in Oct. 2010, there had been a total of 265 cardiac events.

As authors anticipated, they found that the more plaque buildup a subject had, the greater their cardiovascular risk. However, findings also confirmed what some research has suggested: Dense plaque poses less of a threat to subjects’ health than less-dense buildup.

Currently, standard tests evaluating calcium buildup actually associate greater plaque density with greater cardiovascular risk. As a result, it’s possible that our current systems used to predict cardiovascular risk based on plaque buildup may need to be re-evaluated. Although it’s not considered a good thing to have plaque buildup in the arteries, plaque may be less hazardous if it’s denser—perhaps because it’s more stable. And it’s important to take into account this difference when trying to identify those at greatest risk for heart attack and stroke to help prevent risk of these life-threatening events.

Questions for You to Consider

What is coronary artery calcification?

Coronary artery calcification (CAC) is the buildup of calcium in the arteries, which can cause blood vessels to narrow and lead to the development of heart disease.

How is CAC detected?

CAC is detected using a special X-ray called a cardiac computed tomography (CT) scan, which can find build-up of calcium on the walls of the arteries.